SURGERY MANAGEMENT OF PATIENTS WITH IMPLANTED PACEMAKERS AND CARDIOVERTER DEFIBRILLATORS
Abstract
Background The number of patients with implanted pacemakers (PM) and implantable cardioverter/ defibrillators (ICD) is constantly increasing. If these patients need surgery, we have to adapt the procedures during the surgery to prevent complications. The pacemaker may be disturbed by individual sources of electromagnetic field (EMI). This can present as asynchronous pacing, inhibition, stimulation on the upper limit, ventricular fibrillation, burns in the endocardium and pacemaker damage. Implantable cardioverter/defibrillator can be switched off or it can deliver countershocks under the influence of EMI. Recommendations The cardiologist or cardiovascular surgeon must check these patients a short time prior to surgery. During the surgery a bipolar electrocauter or ultrasonic scalpel should be used. The use of a unipolar electrocauter is not recommended for surgery above the waist. If the surgeon uses it anyway, there are some directions that have to be followed, and are described in this article. The function R (R is responsible for physiological rate adapation) of the pacemaker and the implanted cardioverter defibrillator have to be switched off just prior to surgery. In the operating room, an external defibrillator, external pacemaker, a programming device and a magnet should always be present. The patient also has to be checked after the surgery, because failure of the device may not be apparent for up to 48 hours after surgery. Conclusions Pacemakers and cardioverter/defibrillators may be disturbed by individual sources of electromagnetic field. If we consider all the recommendations, the surgery will be much safer for this cohort of patients.Downloads
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
